We herein summarize currently available and clinically relevant information regarding the human immune responses to SARS-CoV-2 infection and vaccination, in relation to COVID-19 outcomes with a focus on acute respiratory distress syndrome (ARDS) and myocarditis.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is common in children, and clinical manifestations can vary depending on age, underlying disease, and vaccination status. Most children will have asymptomatic or mild infection, but certain baseline characteristics can increase the risk of moderate to severe disease. The following article will provide an overview of the clinical manifestations of coronavirus disease 2019 in children, including the post-infectious phenomenon called multisystem inflammatory syndrome in children. Currently available treatment and prophylaxis strategies will be outlined, with the caveat that new therapeutics and clinical efficacy data are constantly on the horizon.

Coronavirus disease 2019 (COVID-19) pneumonia has had catastrophic effects worldwide. Radiology, in particular computed tomography (CT) imaging, has proven to be valuable in the diagnosis, prognostication, and longitudinal assessment of those diagnosed with COVID-19 pneumonia. This article will review acute and chronic pulmonary radiologic manifestations of COVID-19 pneumonia with an emphasis on CT and also highlighting histopathology, relevant clinical details, and some notable challenges when interpreting the literature.

The long-term impacts of coronavirus disease 2019 (COVID-19), or post-acute sequelae of COVID-19 (PASC), are especially pertinent for individuals with systemic autoimmune rheumatic diseases, who are at higher risk of developing COVID-19 infection, complications of acute infection, and possibly PASC. Severity of acute COVID-19 infection, female sex, comorbidities, and immunosuppressive medications impact the risk of PASC in this population. The etiology of PASC remains poorly defined, and the diagnosis is clinical, with symptoms that can overlap with those of rheumatic diseases. A better understanding of the physiologic mechanisms could help to more clearly define PASC and to guide the development of targeted treatments.

This article provides a comprehensive review of the impact of B-cell-directed therapy on severe acute respiratory syndrome coronavirus 2 vaccine immunity, focusing on its implications in autoimmune inflammatory rheumatic diseases (AIIRD). Rituximab (RTX) is the primary B-cell-depleting drug that has been studied in AIIRD and is the focus of this review. We review the pivotal role of B cells in vaccine response and propose strategies to manage and predict vaccine responses in B-cell-depleted individuals. We highlight the need to strategize patients into distinct groups when predicting vaccine responses and developing guidelines to ensure optimal outcomes for RTX-treated patients.

There are estimated tens of millions of individuals throughout the world suffering from a variety of postinfectious sequela following infection with severe acute respiratory syndrome coronavirus 2 also commonly referred to as long coronavirus disease (COVID). Long COVID is providing an opportunity for the field of rheumatology to explore the relationship between similar syndromes including fibromyalgia seen in patients with underlying inflammatory and noninflammatory rheumatic diseases, as well as other postacute infectious sequela and bring our field's traditional skill sets to bear on improving our understanding of these disorders and the care of such patients.

Coronavirus disease 2019 (COVID-19) vaccine uptake among individuals with rheumatic conditions remains low despite heightened risk for related adverse outcomes. This is especially pronounced among historically marginalized populations who suffered disproportionately from the COVID-19 pandemic. Among the myriad of reasons for low vaccine uptake, mistrust in the healthcare system, misinformation related to the vaccine development process, fear of rheumatic disease flares, and inconsistent physician recommendations, are highlighted. Two randomized controlled trials are underway leveraging multimodal strategies and community partnerships to disseminate COVID-19 vaccine information, reduce hesitancy and hopefully improve vaccine uptake, particularly in marginalized communities.

This narrative review summarizes current evidence on the risk of systemic autoimmune rheumatic disease (SARD) flare following coronavirus disease 2019 vaccination. The authors detail key studies in the literature employing diverse methodologies, including cross-sectional surveys, prospective and retrospective cohorts, case-crossover designs, self-controlled case series, and systematic reviews. Data are reassuring, suggesting that vaccination is unlikely to increase the risk of flares across a range of SARD. When postvaccination flares do occur, individuals with high disease activity and frequent flares at baseline may be at higher risk. Rheumatologists may consider discussing these findings with patients during collaborative conversations about risks and benefits of vaccination.

During the COVID-19 pandemic, telemedicine was rapidly deployed to meet the clinical needs of patients with rheumatic diseases worldwide. Rheumatologists were forced to care for patients with all rheumatic diseases, regardless of disease activity, and limited evidence was available to guide provider decision-making regarding telemedicine appropriateness for outpatient rheumatology encounters. As the COVID-19 pandemic progressed, the ongoing provision of rheumatology telemedicine care in the U.S. was made possible by (1) emergency telemedicine waivers that permitted rheumatologists to legally practice across state lines; and (2) increased telemedicine reimbursement rates from the Centers for Medicare and Medicaid Services. Telemedicine research in rheumatology expanded exponentially, and patterns began to emerge regarding multilevel factors associated with telemedicine appropriateness for patients with rheumatic diseases. Rheumatology practice patterns also evolved to address the unique challenges of providing virtual care, such as the use of patient-reported outcomes and physical examination modifications to remotely assess disease activity. Moving beyond the COVID-19 pandemic, telemedicine has the potential to increase access to rheumatology care by utilizing finite rheumatology clinical resources in more efficient and innovative ways. However, barriers to more fully integrating telemedicine into routine rheumatology care remain, including training the rheumatology workforce, suboptimal reimbursement rates for telemedicine services, variability in state telemedicine laws, and the need to build telemedicine support networks of interdisciplinary and interprofessional care team members. As the use of telemedicine in rheumatology continues to evolve, it is vital for rheumatologists to maintain a patient-centered focus in the continued delivery of safe, effective, and equitable rheumatology care.

The coronavirus disease 2019 (COVID-19) pandemic severely impacted patients with rheumatic musculoskeletal diseases (RMDs), worsening health disparities, disrupting care, and affecting mental health. RMD patients, especially from marginalized communities, faced heightened COVID-19 susceptibility and severe outcomes. Telemedicine emerged as an important tool for maintaining access to care during the early pandemic period but highlighted disparities in access to the necessary technologies. Despite vaccinations providing protection in the general population, they were not effective in some patients with RMDs, especially those using B cell depletion therapies. Tailored management strategies and ongoing support, including mental health resources, are essential as COVID-19 persists.

Immunocompromised hosts, which encompass a diverse population of persons with malignancies, human immunodeficiency virus disease, solid organ, and hematologic transplants, autoimmune diseases, and primary immunodeficiencies, bear a significant burden of the morbidity and mortality due to coronavirus disease-2019 (COVID-19). Immunocompromised patients who develop COVID-19 have a more severe illness, higher hospitalization rates, and higher mortality rates than immunocompetent patients. There are no well-defined treatment strategies that are specific to immunocompromised patients and vaccines, monoclonal antibodies, and convalescent plasma are variably effective. This review focuses on the specific impact of COVID-19 in immunocompromised patients and the gaps in knowledge that require further study.

This review highlights the key role of imaging modalities in diagnosing and managing myositis. The authors underscore MRI's superiority in identifying muscle edema and fat infiltration, marking it as essential for evaluating disease activity and damage. They also suggest ultrasound's emerging significance for diagnosis and monitoring of the disease, valued for its ease of use, and real-time capabilities. Furthermore, PET scans' unique physiologic capabilities, especially useful for malignancy detection and assessing lung disease, are emphasized. Collectively, these imaging techniques offer a tailored approach to myositis management, facilitate precise diagnosis, effective treatment planning, and disease activity monitoring, thereby enhancing patient outcomes in rheumatology practice.

Crystalline arthropathies are among the most frequently encountered conditions in medicine. Joint aspiration and microscopy used to be the diagnostic gold standard, but recent recommendations mention that this may not be necessary if typical findings are seen on imaging. Ultrasound, dual-energy computed tomographic (CT) scan, and conventional radiography are recommended in the assessment of gout, calcium pyrophosphate crystal deposition disease, and basic calcium phosphate-related disease. Ultrasound can identify the tophus and its associated tissues that participate in the inflammatory response, and dual-energy CT can find tophaceous material in regions that are difficult to access by physical examination or ultrasound.

This review examines the role of various imaging techniques in assessing vascular and musculoskeletal manifestations in Systemic Sclerosis (SSc). Imaging modalities, such as thermography, capillaroscopy, ultrasound, optical coherence tomography, laser speckle contrast analysis, radiography, computed tomography, and MRI, offer valuable insights into SSc-related complications. Findings suggest that these techniques aid in diagnosing conditions like Raynaud phenomenon, digital ulcers, calcinosis, acro-osteolysis, and hand contractures. However, each modality has its advantages and limitations, necessitating a multimodal approach for comprehensive evaluation and accurate diagnosis of SSc-related manifestations.

Salivary gland involvement is a common feature of rheumatologic disease. The authors review the anatomy of the major salivary glands and the uses of imaging modalities such as ultrasound, MRI, computed tomography, sialography, and scintigraphy in evaluating the major salivary glands in rheumatologic disease.

The incidence of inflammatory bowel disease (IBD) is rising globally. We need more tools and techniques in our armamentarium for early diagnosis, tight monitoring, and to assess disease complications of IBD. This article reviews the role of cross-sectional imaging, mainly computed tomography, MRI, and intestinal ultrasound (IUS) in IBD and its advantages, disadvantages, and limitations. While popular in other parts of the world, IUS is underutilized in the United States. It is safe, accurate, can be repeated multiple times and provides quick and actionable results in IBD care without the risk of radiation and contrast.

Immune-mediated systemic inflammatory disorders present a latent threat for cardiovascular disease. Early involvement may be associated with constitutional symptoms, while clinical evidence of disease may manifest later in an insidious manner. Multimodality imaging is crucial to detect myocardial involvement, with transthoracic echocardiogram as a first-line imaging modality; however, cardiac MRI (CMRI) has the potential to significantly impact our diagnostic and therapeutic approaches through high-fidelity chamber quantification and parametric mapping techniques. Novel imaging techniques are currently under investigation, including stress CMRI, feature tracking CMR, late gadolinium enhancement (LGE) entropy, and 4 dimensional flow CMRI.